Crossed
Bilingual
Aphasia
in
a
Chinese
Dextral
To the Editor.\p=m-\Withreference to
our
article, "Crossed Aphasia in a Chinese Bilingual Dextral" (Arch Neurol 34:766, 1977), we have recently examined
We believe that a at this time would be of interest to the readership of the Archives. a
second
case.
preliminary description
Report of a Case.\p=m-\A72-year-old righthanded bilingual Chinese man had an ictus on March 25, 1978. After regaining consciousness 45 minutes later, he had leftsided hemiparesis, including face and anarthria. This neurologic deficit has persisted until the present time, 55 days later. Sensorimotor and reflex testing showed no abnormalities in the right upper and lower limbs. Electroencephalogram showed right frontotemporal delta focus with normal rhythms from left leads. Computerized tomography scan showed a localized hemorrhagic infarction in the right frontotemporal area. Dynamic and static isotope scans confirmed the presence of a lesion in the distribution of right middle cerebral artery.
Speech-language testing in Chinese (Cantonese) and English demonstrated persistent anarthria with apraxia of buc¬ cal-lingual movements. Indirect laryngoscopy, palatal movements, and gag reflex were normal. The tongue was not atrophie. Three step commands, token tests, reckon¬ ing, and drawing to command were preserved. There was difficulty writing to dictation and trouble with simple reading comprehension. The striking feature was that his performance was equally good or bad in Chinese and English and that calli¬ graphic features of writing were excellent in both languages. Neuropsychologic tests in English produced the following scores. Wechsler Adult Intelligence Scale per¬ deficits in all
formance score was 74; parts of the Benton Visual Retention Test; 28 on Raven's Coloured Progressive Matrices; Peabody Picture Vocabulary ceiling 72 with 17 errors.
Comment— Compared with the pa¬ tient we described previously, this case of crossed aphasia showed two
noteworthy features-persistent anar¬ thria and equal dysfunction in both languages. The first feature is conso¬ nant with previous reports of crossed aphasia1 and may relate to the "juve¬ nile" pattern of cerebral language organization hypothesized by some to
account for inverted language domi¬ nance.2 The second feature is another exception to the so-called law of
Pitres.3 We will be interested to observe the aphasie pattern that finally emerges during future recovery. We have been impressed by having seen two such unusual cases of crossed aphasia in such a short period of time. We are led to ask whether crossed aphasia might be a more common pattern in Chinese patients than hitherto recognized. A systematic approach is being pur¬ sued. Robert S. April, MD New York Med Coll Bird S. Coler Hosp Roosevelt Island New York, NY 10017 Peter C. Tse, MD 150-27 78th Rd Flushing, NY 11367
infarction in the left inferior temporal lobe. Serotonin deficiency was demonstrated.1 This pathological yawning seemed to be a dose-related side effect of valproate sodium that has not been previously reported. Pimozide, a do¬ pamine antagonist, was used by Mogilnicka and Klimek2 to reduce the yawning in rats produced by dopa¬ mine agonists. A theoretical possibili¬ ty is that valproate sodium led to the stimulation of dopaminergic neurons, thereby producing the yawning that was in turn alleviated by the adminis¬ tration of pimoxide. R. D. Rollison, MB W. S. Wiggins, MD B. S. Gilligan, FRACP
Dept of Neurol Bowman Gray School of Med Winston-Salem, NC 27103
Nonproprietary Name and Trademark of Drug Valproate sodium—Depakene. 1. Rollinson RD, Gilligan BS: Post-anoxic action myoclonus (Lance-Adams syndrome) responding to sodium valproate. Arch Neurol, to be
published. 2. Mogilnicka E, Klimek V: Drugs affecting dopamine neurones and yawning behaviour. Pharmacol Biochem Behav 7:303-305, 1977.
1. Brown J, Wilson FR: Crossed aphasia in a dextral. Neurology 23:907, 1973. 2. Brown J, H\l=e'\caenH: Lateralization and
Carotid Arterial Occlusion in Identical Twins With Moyamoya
1976. 3. Pitres A: Etude sur l'aphasie chez les glottes. Rev Med 15:873, 1895.
To the Editor.\p=m-\Werecently observed carotid arterial occlusion in identical twins, one of whom also had moya-
language representation. Neurology 26:183,
Poly-
Drug-Induced Yawning Successfully
Treated With Pimozide
To the Editor.\p=m-\We recently had a patient who had postanoxic action myoclonus (Lance-Adams syndrome).
This
severe
movement disorder
was
completely suppressed with the oral administration of valproate sodium (Epilim [Britain]; Depakene, comparable US product) at a dosage of 1,000 mg daily, with corresponding serum levels of 50 to 80 \g=m\g/mL. At these
levels and while receiving no therapy, severe uncontrollable yawning developed. This was occurring every two to three minutes. Lowering the dosage of the valproate sodium abolished the yawning, and its reinstitution at the previous level led to its return. Pimozide (Orap), 400 mg daily, was added to the regimen of full dosage of valproate sodium, and the yawning disappeared within one day. Withdrawal of the pimozide caused the yawning to reappear. Computerized tomography of the brain demonstrated mild generalized cortical atrophy with an area of serum
other
moya.
Report of Cases.\p=m-\Case1.\p=m-\A2-year-old boy, the first of identical twins, was admitted to our Institute of Neurology in October 1974 with left hemiparesis and dysphasia of two days' duration. There was no history of head injury, fever, convulsions, or ear infection. Carotid arterial pulsations were normal. Routine laboratory test results and the CSF were normal. A Mantoux test with PPD strength of 5TU/ 0.1 mL was negative. The EEG showed slow waves on the right. Right carotid angiography showed occlusion of the internal carotid artery at the siphon and a leash of vessels surrounding that region, typical of moyamoya. The child displayed normal speech and residual hemiparesis three years later. Case 2.\p=m-\Thesecond of the twins, a 4\x=req-\ year-old boy was hospitalized in February 1976 with sudden loss of speech and right hemiparesis of six days' duration. This followed a minor respiratory and gastroin¬ testinal infection. The left carotid pulsa¬ tion was feeble. Routine laboratory test results and the CSF were normal. Serum lipoprotein profile was consistent with hyperprebetalipoproteinemia. A Mantoux
Downloaded From: http://archneur.jamanetwork.com/ by a University of British Columbia Library User on 06/21/2015
Bilingual
Aphasia
in
a
Chinese
Dextral
To the Editor.\p=m-\Withreference to
our
article, "Crossed Aphasia in a Chinese Bilingual Dextral" (Arch Neurol 34:766, 1977), we have recently examined
We believe that a at this time would be of interest to the readership of the Archives. a
second
case.
preliminary description
Report of a Case.\p=m-\A72-year-old righthanded bilingual Chinese man had an ictus on March 25, 1978. After regaining consciousness 45 minutes later, he had leftsided hemiparesis, including face and anarthria. This neurologic deficit has persisted until the present time, 55 days later. Sensorimotor and reflex testing showed no abnormalities in the right upper and lower limbs. Electroencephalogram showed right frontotemporal delta focus with normal rhythms from left leads. Computerized tomography scan showed a localized hemorrhagic infarction in the right frontotemporal area. Dynamic and static isotope scans confirmed the presence of a lesion in the distribution of right middle cerebral artery.
Speech-language testing in Chinese (Cantonese) and English demonstrated persistent anarthria with apraxia of buc¬ cal-lingual movements. Indirect laryngoscopy, palatal movements, and gag reflex were normal. The tongue was not atrophie. Three step commands, token tests, reckon¬ ing, and drawing to command were preserved. There was difficulty writing to dictation and trouble with simple reading comprehension. The striking feature was that his performance was equally good or bad in Chinese and English and that calli¬ graphic features of writing were excellent in both languages. Neuropsychologic tests in English produced the following scores. Wechsler Adult Intelligence Scale per¬ deficits in all
formance score was 74; parts of the Benton Visual Retention Test; 28 on Raven's Coloured Progressive Matrices; Peabody Picture Vocabulary ceiling 72 with 17 errors.
Comment— Compared with the pa¬ tient we described previously, this case of crossed aphasia showed two
noteworthy features-persistent anar¬ thria and equal dysfunction in both languages. The first feature is conso¬ nant with previous reports of crossed aphasia1 and may relate to the "juve¬ nile" pattern of cerebral language organization hypothesized by some to
account for inverted language domi¬ nance.2 The second feature is another exception to the so-called law of
Pitres.3 We will be interested to observe the aphasie pattern that finally emerges during future recovery. We have been impressed by having seen two such unusual cases of crossed aphasia in such a short period of time. We are led to ask whether crossed aphasia might be a more common pattern in Chinese patients than hitherto recognized. A systematic approach is being pur¬ sued. Robert S. April, MD New York Med Coll Bird S. Coler Hosp Roosevelt Island New York, NY 10017 Peter C. Tse, MD 150-27 78th Rd Flushing, NY 11367
infarction in the left inferior temporal lobe. Serotonin deficiency was demonstrated.1 This pathological yawning seemed to be a dose-related side effect of valproate sodium that has not been previously reported. Pimozide, a do¬ pamine antagonist, was used by Mogilnicka and Klimek2 to reduce the yawning in rats produced by dopa¬ mine agonists. A theoretical possibili¬ ty is that valproate sodium led to the stimulation of dopaminergic neurons, thereby producing the yawning that was in turn alleviated by the adminis¬ tration of pimoxide. R. D. Rollison, MB W. S. Wiggins, MD B. S. Gilligan, FRACP
Dept of Neurol Bowman Gray School of Med Winston-Salem, NC 27103
Nonproprietary Name and Trademark of Drug Valproate sodium—Depakene. 1. Rollinson RD, Gilligan BS: Post-anoxic action myoclonus (Lance-Adams syndrome) responding to sodium valproate. Arch Neurol, to be
published. 2. Mogilnicka E, Klimek V: Drugs affecting dopamine neurones and yawning behaviour. Pharmacol Biochem Behav 7:303-305, 1977.
1. Brown J, Wilson FR: Crossed aphasia in a dextral. Neurology 23:907, 1973. 2. Brown J, H\l=e'\caenH: Lateralization and
Carotid Arterial Occlusion in Identical Twins With Moyamoya
1976. 3. Pitres A: Etude sur l'aphasie chez les glottes. Rev Med 15:873, 1895.
To the Editor.\p=m-\Werecently observed carotid arterial occlusion in identical twins, one of whom also had moya-
language representation. Neurology 26:183,
Poly-
Drug-Induced Yawning Successfully
Treated With Pimozide
To the Editor.\p=m-\We recently had a patient who had postanoxic action myoclonus (Lance-Adams syndrome).
This
severe
movement disorder
was
completely suppressed with the oral administration of valproate sodium (Epilim [Britain]; Depakene, comparable US product) at a dosage of 1,000 mg daily, with corresponding serum levels of 50 to 80 \g=m\g/mL. At these
levels and while receiving no therapy, severe uncontrollable yawning developed. This was occurring every two to three minutes. Lowering the dosage of the valproate sodium abolished the yawning, and its reinstitution at the previous level led to its return. Pimozide (Orap), 400 mg daily, was added to the regimen of full dosage of valproate sodium, and the yawning disappeared within one day. Withdrawal of the pimozide caused the yawning to reappear. Computerized tomography of the brain demonstrated mild generalized cortical atrophy with an area of serum
other
moya.
Report of Cases.\p=m-\Case1.\p=m-\A2-year-old boy, the first of identical twins, was admitted to our Institute of Neurology in October 1974 with left hemiparesis and dysphasia of two days' duration. There was no history of head injury, fever, convulsions, or ear infection. Carotid arterial pulsations were normal. Routine laboratory test results and the CSF were normal. A Mantoux test with PPD strength of 5TU/ 0.1 mL was negative. The EEG showed slow waves on the right. Right carotid angiography showed occlusion of the internal carotid artery at the siphon and a leash of vessels surrounding that region, typical of moyamoya. The child displayed normal speech and residual hemiparesis three years later. Case 2.\p=m-\Thesecond of the twins, a 4\x=req-\ year-old boy was hospitalized in February 1976 with sudden loss of speech and right hemiparesis of six days' duration. This followed a minor respiratory and gastroin¬ testinal infection. The left carotid pulsa¬ tion was feeble. Routine laboratory test results and the CSF were normal. Serum lipoprotein profile was consistent with hyperprebetalipoproteinemia. A Mantoux
Downloaded From: http://archneur.jamanetwork.com/ by a University of British Columbia Library User on 06/21/2015
